Not long ago, I had a nice email exchange with a sales manager with one of the top ambulatory EMR vendors. He had written to comment on “The EMR Vendor’s Dilemma,” a piece I wrote about the difficult choices such vendors face in staying just slightly ahead of the market.
In our correspondence, he argued that Meaningful Use (MU) had led customers to see EMRs as commodities. I think he meant that MU sucked the innovation out of EMR development.
After reflecting on his comments, I realized that I didn’t quite agree that EMRs had become a commodity item. Though the MU program obviously relied on the use of commoditized, certified EMR technology, I’d argue that the industry has simply grown around that obstacle.
If anything, I’d argue that MU has actually sparked greater innovation in EMR development. Follow me for a minute here.
Consider the early stages of the EMR market. At the outset, say, in the 50s, there were a few innovators who figured out that medical processes could be automated, and built out versions of their ideas. However, there was essentially no market for such systems, so those who developed them had no incentive to keep reinventing them.
Over time, a few select healthcare providers developed platforms which had the general outline EMRs would later have, and vendors like Epic began selling packaged EMR systems. These emerging systems began to leverage powerful databases and connect with increasingly powerful front-end systems available to clinicians. The design for overall EMR architecture was still up for grabs, but some consensus was building on what its core was.
Eventually, the feds decided that it was time for mass EMR adoption, the Meaningful Use program came along. MU certification set some baselines standards for EMR vendors, leaving little practical debate as to what an EMR’s working parts were. Sure, at least at first, these requirements bled a lot of experimentation out of the market, and certainly discouraged wide-ranging innovation to a degree. But it also set the stage for an explosion of ideas.
Because the truth is, having a dull, standardized baseline that defines a product can be liberating. Having a basic outline to work with frees up energy and resources for use in innovating at the edges. Who wants to keep figuring out what the product is? There’s far more upside in, say, creating modules that help providers tackle their unique problems.
In other words, while commoditization solves one (less interesting) set of problems, it also lets vendors focus on the high-level solutions that arguably have the most potential to help providers.
That’s certainly been the case when an industry agrees on a technology specification set such as, say, the 802.11 and 802.11x standards for wireless LANs. I doubt Wi-Fi tech would be ubiquitous today if the IEEE hadn’t codified these standards. Yes, working from technical specs is different than building complex systems to meet multi-layered requirements, but I’d argue that the principle still stands.
All told, I think the feds did EMR vendors a favor when they created Meaningful Use EMR certification standards. I doubt the vendors could have found common ground any other way.